"President Bush has made the global effort to eradicate AIDS one of his highest foreign policy priorities," Powell told the Global Business Coalitions on HIV/AIDS.

Last month, Bush signed into law a $15 billion program to combat AIDS in Africa and the Caribbean and said he would challenge other industrial democracies to boost their commitments.

Powell said "the United Kingdom, France and the European Union are meeting that challenge" by increasing their commitment to fight AIDS.

"Governments can't meet that challenge alone," Powell said. "It has to be done in partnership with businesses, faith-based institutions and other organizations."

Powell said "the HIV virus, like terrorism, kills indiscriminately. It is more destructive than any army, any conflict, any weapon of mass destruction."

He said the spread of AIDS "can destroy countries and destabilize entire regions. We see it spreading all over the world."

Powell said nations facing the threat "will have to take their head out of the sand and deal with these problems."

Powell praised the work of the 114 companies involved in the Global Business Coalition for their efforts to educate their workers about AIDS and to help their communities combat the disease.

The coalition honored two companies for their work in educating their workers and communities about the threat of AIDS — Standard Chartered Bank, an international commercial bank that focuses on emerging markets, and Tata Steel, an Indian company.

The group also heard from Senate Majority Leader Bill Frist, R-Tenn., and Sen. John Kerry, D-Mass., who have been leaders in Congress' efforts to increase investment in the fight against AIDS.

Frist told of the devastating effect he's seen AIDS have on families and entire communities, while Kerry said the destruction of a developing nation's economy and hope can be a fertile breeding ground for terrorism.

LONDON (Reuters) - Secretary of State Colin Powell said on Saturday U.S. funds of up to $15 billion to combat HIV/AIDS would include spending on education to foster sexual abstinence in polygamous African societies.

Speaking to CNN television, Powell also said Washington was working closely with drugs companies and the United Nations to bring down the costs of anti-retroviral treatments sought by millions of sufferers of HIV in poor countries.

"Polygamous means you have more than one partner but it's within some family unit. What we're saying is that young people especially should be very careful about indiscriminate sex... Abstention means that you are protected," Powell said.

"We think it is a much better approach to become sexually active when you are mature and if it's within the institution of marriage, that's even better.

"The president of Uganda has put in place a program that essentially follows this line: abstinence, faithfulness and then if there are still dangers...then use condoms to protect yourself."

On May 27 President Bush) signed into law a $15 billion plan to help combat AIDS in Africa and the Caribbean, tripling U.S. spending on the disease over the next five years.

Critics said the proposed budget for next year included just over half of the $3 billion promised.

Powell said that over the past three years the price of anti-retroviral drugs had dropped significantly, but he acknowledged it still had to go down even more.

"We're working with drug companies, we're working with (U.N.) Secretary-General Kofi Annan, it's important to get the price down even lower.

"So there are many things we have to do... We have to get the delivery systems in place so these drugs can be administered...and we have to educate people so they won't need these drugs in the first place, we have to continue to invest in a cure for HIV/AIDS.

"So we have to attack this problem on every front."

The AIDS initiative focuses principally on Botswana, Ivory Coast, Ethiopia, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda and Zambia, as well as Guyana and Haiti in the Caribbean.

Some 20 million to 25 million people have died of AIDS and at least 40 million more are infected with HIV, with Africa and the Caribbean having high rates of infection.

WASHINGTON (Reuters) - International business has vastly increased efforts to combat AIDS, but many more companies must join the fight against the 21st century's greatest scourge, government and corporate leaders say.

At a dinner at the Kennedy Center on Wednesday night, the Global Business Coalition (GBC) on HIV/AIDS hailed its expansion from 17 to 114 companies, and speakers praised member firms like Standard Chartered Bank PLC, Tata Steel of India and Daimler-Chrysler.

"I commend ... all 114 members of the GBC for confronting the AIDS crisis directly," said Secretary of State Colin Powell, who called the AIDS pandemic "every bit as much of a crisis as Iraq."

But Richard Holbrooke, a former U.S. diplomat who is president of the New York-based coalition, warned that despite notable achievements -- including growing to encompass 4 million workers in 178 countries -- more remained to be done.

Calling AIDS the "ultimate weapon of mass destruction" that kills 13,000 people every day, Holbrooke said, "Most of the business community has still not done more than a fraction of what it should do ... The harsh truth is that far too few companies are fully engaged yet in this fight."

While many companies don't do business in AIDS-ravaged Africa, the disease is fast spreading to other regions, and helping to arrest the trend is in the financial interest of all companies, Holbrooke said.

Chris Keljik, group executive director for Standard Chartered Bank, said his organization believes "all companies have a duty to care for their people and the communities in which they do business."

The 150-year-old bank, with 30,000 employees and operations in Asia, the Middle East, Africa and Latin America, was honored for campaigns to educate staff about AIDS and provide support services for those affected by the disease.

Tata Steel, founded in 1907 and employing 43,000 workers, is India's largest private sector steel company. It was honored for a program to encourage HIV/AIDS prevention through mass awareness and prevention.

"We need to fight this as a war," said chairman Ratan Tata.

By MICHAEL SMITH, Associated Press Writer

PORT-OF-SPAIN, Trinidad - A worker holds the painfully thin boy's hand as he walks unsteadily through the cramped orphanage to join other children saying their ABCs.

The 5-year-old already has been diagnosed with full-blown AIDS. But his health has improved since he arrived in October and started taking antiretroviral drugs and receiving regular care.

"We didn't expect him to live, but you see him walking now," said Judy Nimblett, manager of Trinidad's Cyril Ross Nursery, home to 33 orphaned children infected with HIV and AIDS. It is run by the Roman Catholic St. Vincent de Paul Society.

But the cash-strapped orphanage and many other Caribbean programs will not benefit from President Bush's $15 billion U.S. package to fight AIDS — because they are not in Haiti or Guyana.

Touted by President Bush as one of the largest initiatives taken against a disease, the five-year package focuses on 12 African countries and two of the Caribbean's hardest-hit nations, Haiti and Guyana.

While Caribbean officials acknowledge Haiti and Guyana are in dire need of help, they say targeting specific countries rather than the region could be disastrous in the long run.

The Caribbean has the world's second-highest infection rate, 2.4 percent, after sub-Saharan Africa's 8.8 percent.

Heavy travel between Caribbean islands — a prime spot for U.S. tourists — could allow the disease to spread quickly. What's more, tiny countries have nowhere near the resources to deal with the problem, officials say.

Several leaders, including Prime Minister Denzil Douglas of St. Kitts and Nevis, plan to present their case to the Bush administration while they are in Washington this week for a World Bank symposium.

Edward Greene, assistant secretary-general of the 15-nation Caribbean Community, said he and others will be on a panel with U.S. Health and Human Services Secretary Tommy Thompson to discuss the region's response to the epidemic.

"Relatively modest investments are what are needed here to prevent an Africa-like catastrophe," said Dr. James Hospedales, director of the Trinidad-based Caribbean Epidemiology Center.

The United States would also gain from greater spending in the Caribbean, regional leaders say, because of heavy migration to the United States and the millions of Americans who vacation here.

Money is desperately needed for a long list of programs, including treatment of pregnant women with AIDS to reduce the number of babies born with HIV, they say.

The Bush administration says other U.S. initiatives provide help to the rest of the Caribbean, including U.S. contributions to the U.N.-initiated Global Fund to Fight AIDS, Tuberculosis and Malaria and programs operated through the U.S. Agency for International Development.

Studies by economists at the University of the West Indies show failing to slow the spread of the disease will deeply affect economies because those infected tend to be younger people who make up a large part of the work force.

With more financing, the region could run a Caribbean-wide education campaign, improve laboratories and testing to better identify those infected and purchase more drugs to treat victims, regional leaders say.

"If left as is, with the trends as they are, every sector of society will suffer," said Dr. Amery Browne, chairman of CARE, an AIDS advocacy group in Trinidad.

By Wambui Chege

JOHANNESBURG (Reuters) - A meeting between the top AIDS advisory body to the South African government and activists Saturday ended with no word on a long-awaited decision on when the state would roll out life-saving AIDS drugs.

But leading lobby group Treatment Action Campaign (TAC) claimed a small victory after the meeting with the South African National AIDS Council (SANAC), saying the government's adviser had recognized the urgency of the plight of HIV/AIDS victims in the country.

South Africa has the highest number of people living with HIV/AIDS in the world, estimated at 4.7 million or about a tenth of the world's infected.

But AIDS groups have criticized South Africa's government for moving too slowly on the disease and refusing to provide the life-saving drugs, which it says are too dangerous and costly.

Deputy President Jacob Zuma said in a statement the government was at an advanced stage of dealing with a report by a state-appointed team examining the feasibility of providing anti-retrovirals within the public health system.

Zuma said a decision would be announced as soon as possible.

"From our point of view, this is a breaking of a log-jam and we hope that government will act very urgently," TAC Chairman Zackie Achmat said.

Thousands of AIDS activists suspended a nationwide civil disobedience campaign ahead of a meeting in May at which they hoped the government would agree to provide the drugs.

But the government has dragged its feet, despite the report by the team of health and finance ministry officials, which local media said came out in favor of a national anti-retroviral drugs program phased in over five years.

AIDS groups say about 600 South Africans die each day from the disease which U.N. officials say will cost the country an estimated $22 billion in lost economic development by 2010.

"We really are giving the government its last opportunity. I can tell you over the next few weeks, we will move heaven and earth to make sure we have a national treatment plan," Achmat said.

Achmat, who is HIV-positive, has refused to take anti-retrovirals until the government changes its mind. The triple-therapy drug cocktails are available privately or for those with medical aid, putting them out of reach of many ordinary South Africans.

By Sharon Lerner Village Voice Writer

The long-awaited breakthrough in AIDS treatment is finally here. In mid March, the Food and Drug Administration approved Fuzeon, the first drug in the first new class of anti-HIV medications to be introduced in more than seven years. Fuzeon is like a dream for some 150,000 people—the roughly 30 percent of those on HIV medication who are resistant to existing antiretrovirals and are running out of treatment options.

But Fuzeon may remain just a fantasy for the poor and uninsured. Priced at a staggering $19,990 for a year's supply, the first of the new "fusion inhibitors" is by far the most expensive AIDS medication ever made. Compare it to a year's worth of three antiviral drugs, say Crixivan, Zerit, and DDI, a typical combination that totals between $10,000 and $12,000 per year. Then realize that Fuzeon is supposed to be taken along with those or other antiviral meds, bringing the tab for one year's worth of treatment to upward of $30,000, and you'll see why the wonder drug is setting off one of the stickiest ethical AIDS crises yet.

"Only rich people will be able to survive AIDS beyond a certain threshold now," warns Clint Trout, associate director of federal government affairs at the AIDS Healthcare Foundation in Los Angeles. "There's no way government programs can absorb the cost of this drug. With the state budget crises, the money just isn't there."

Indeed, in its first weeks on the market, Fuzeon—of which, because of limited raw materials, there will only be enough to treat 8,000 to 10,000 patients this year—seems to be scarcest for the people with the least money. Most state Medicaid programs, which insure the poor, have agreed to cover Fuzeon, but budget cuts may make that impossible. And while 94 percent of the largest private health insurers have agreed to pay for the drug at least as a last resort, the country's largest purchasers of AIDS meds, which serve the poor and uninsured, are far less likely to cover it. Only a quarter of the state AIDS Drug Assistance Programs, which use federal and state funds to pay for antiviral meds for more than 135,000 HIV-infected people, have added Fuzeon to their formularies. And that's after Roche, which is marketing Fuzeon, agreed to sell it to ADAPs at an undisclosed discount. (In mid May, just days after that decision, New York's program began covering Fuzeon.)

Even before Fuzeon came on the scene, ADAPs were already struggling. As of February, 16 of the programs had either closed enrollment to new clients, reduced the number of drugs they supply, or limited access to new anti-HIV medications. (New York's ADAP restricted its list of drugs.) Now Fuzeon may push the safety net of drug providers to the brink. William E. Arnold, director of the ADAP Working Group in Washington, D.C., estimates that Fuzeon will cost ADAPs $28 million in the current fiscal year. "That will force every state to go make triage decisions," says Arnold. Morally and ethically, that's no place to go."

The last time a drug was introduced at such an inaccessible price, it set off a furor: ACT UP members chained themselves to a balcony in the stock exchange and took over drug company offices to protest AZT's then exorbitant price of $10,000 a year. This time, a coalition of 29 AIDS organizations has petitioned Roche and Trimeris, Inc. to lower the drug's price. But the two companies that developed and are now marketing Fuzeon together seem unlikely to change course, blaming Fuzeon's whopping price tag on its complicated, 106-step manufacturing process. "We really are charging the price that we must charge," insists Roche spokesperson Heather Van Ness. Just one batch of Fuzeon takes six months and the work of hundreds of people to make, according to Van Ness, who says the companies invested more than $600 million in Fuzeon's development.

There is no way to verify the companies' precise manufacturing costs, but whatever they are, the companies should more than recoup them as early as next year, according to industry analysts. By 2005, the drug's profits will likely be around $800 million, says pharmaceutical specialist David Bouchey of C.E. Unterberg, Towbin. If Roche decides to build another manufacturing plant, allowing it to double its production, Bouchey says, Fuzeon could easily end up in blockbuster drug territory, reserved for pharmaceuticals that make $1 billion or more.

The prospect of companies making so much money while desperate patients are left out in the cold is at the heart of the uproar over Fuzeon. While rage helped bring the price of AZT down from $10,000 to $3,600 per year in the U.S. and pave the way for generic versions to be sold in some countries for a mere $300 per year, affordable prices for Fuzeon are likely still far off. At this point, no one is even discussing the possibility of distribution in poor countries; generic companies don't yet know how to copy the drug, and even with the U.S. promising $15 billion to fight AIDS in Africa and the Caribbean, there isn't nearly enough money in those regions to buy it. Activists, who fear the price tag has raised the bar for what drug companies might charge for future AIDS drugs, may ultimately get Fuzeon's price down. But, for now, urgent demand and a limited supply mean that the drug will elude many even in this country.

SAN FRANCISCO - Federal health officials have warned an HIV/AIDS prevention program that its federal funding will be cut if it does not stop offering classes that "encourage or promote sexual activity."

The federal Centers for Disease Control and Prevention specifically criticized the nonprofit Stop AIDS Project for a workshop that offers guidelines on "safe and friendly relations" with male prostitutes, another that discusses oral sex and a third entitled "Bootylicious" that provides tips for successful anal intercourse.

Friday's warning, announced in a letter, came four months after the agency cleared Stop AIDS following a review prompted by complaints from Rep. Mark E. Souder, R-Ind. Souder's objection to the sexually explicit nature of the program prompted a national review of all federally funded HIV/AIDS programs.

Stop AIDS officials said they believe the CDC's latest challenge came in response to political pressure from some congressional Republicans and the Bush administration.

"It seems that it's about politics, not about public health," said Shana Krochmal, a spokeswoman for the 15-year-old group.

Krochmal said all Stop AIDS programs are designed with input from residents and approved by a panel appointed by the San Francisco Department of Public Health.

In a separate letter, the CDC asked the health department to improve its monitoring of HIV-prevention programs and reject ones with titles and descriptions that appear to "directly promote or encourage sexual activity."

About one-third of Stop AIDS' $1.8-million annual budget comes from the federal government.

Mitchell Katz, the director of the health department, said that if CDC cuts the program's funds, city money would be used to ensure it continues.

"We in San Francisco believe that to reach the men who have sex with men who are at highest risk of HIV transmission, we need to speak the same language they do, and we need to have workshops that draw them in," Katz said.

In February, federal health reviewers concluded that workshops with names such as "A Walk on the Wildside" and "Guy Watch" were based on "current behavioral science theories in the area of health promotion" and consistent with locally determined standards of decency.

Sydney doctors Nicholas Harvey and King Weng Chen had argued that doctor-patient confidentiality prevented them from telling the woman, identified only as PD, that her fiance had HIV before they got married.

But New South Wales Supreme Court Judge Jerrold Cripps said the doctors did not make it clear to their patient, identified as FH, that he had to inform his bride of his medical condition.

Cripps awarded $727,437 in damages to the 28-year-old woman, who had unprotected sex with her husband in the belief they had both tested negative for HIV.

A court official said it was unclear whether the doctors would appeal.

By Gonzalo Argandona

SANTIAGO (Reuters Health) - After three days of negotiations in Lima, Peru, the health ministers of 10 Latin American nations signed a collective agreement with pharmaceutical companies to reduce the costs of drug treatment for people with HIV.

According to a document released at the end of the meeting, the governments got a reduction of up to 72 percent in the price of antiretroviral drugs and up to 60 percent for reactives used for the diagnosis of HIV.

Together, the price cuts will allow the inclusion of more than 150,000 people who previously had no access to such products.

"We have agreed a maximum referential common price for all countries," said the final text signed by public health authorities from Argentina, Bolivia, Colombia, Chile, Ecuador, Mexico, Paraguay, Peru, Uruguay and Venezuela.

The pharmaceutical companies that signed the agreement were Abbot, Bayer, Becton Dickinson, Biomerieux, Roche Diagnostics, Richmond, Refasa, Combino Pharm, Ranbaxi, Rontag, Cipla and Filaxis.

"This is one of the most ambitious agreements reached so far in the world between governments and laboratories. It will allow HIV treatments at sustainable costs for Latin American countries," Anabella Arredondo, director of the Chilean National Committee on AIDS(CONASIDA), who was in on the negotiations, told Reuters Health.

Fernando Carbone, health minister of Peru and president of the meeting, commented that the agreement will permit "the extension of medical coverage, as well as the management of AIDS, in very favorable terms."

A recent survey carried out by the Pan American Health Organization (PAHO) determined that the prices of antiretroviral therapy in Latin America showed wide differences among the countries surveyed, with some nations paying up to 10 times more for the same drug.

Given that scenario, the new regional policy for HIV products -- valid for the next 12 months -- stipulates that laboratories now must offer their products at the same maximum price for all 10 countries that signed the agreement. The acquisitions carried out by states will be implemented under local regulations, with each government able to negotiate further discounts.

The meeting in Peru was the last step of a complex process of negotiations that began more than six months ago. It included manufacturers of generics as well as brand-name drugs.

Sources consulted by Reuters Health said that all producers of original antiretroviral drugs first refused to establish a maximum referential price until one company accepted this policy.

Based on the results of this process, the health ministers of the 10 Latin American countries proposed the launch of a global policy for the negotiation of drug prices.

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